Continuous zigzag excision: A surgical technique for keloids of the auricular helix after burn injury

The auricle is vulnerable to burn injury because of its anatomical location. Auricular keloids that form after burns can have significant psychosocial and quality-of-life effects. We developed a new surgical technique to treat this type of keloid-the continuous zigzag excision technique-and report our experience here.

A retrospective clinical study was carried out on consecutive patients with helix keloids who underwent reconstruction using continuous zigzag excision between January 2018 and December 2023. The data analyzed included patients' medical history, physical examination findings, ear photographs, surgical information, and pre- and post-operative Vancouver scar scale (VSS) scores, along with patient satisfaction.

A total of 24 patients with 36 helix keloids were included in the study. Among them, 18 patients with 28 helix keloids (77.8 %) were either satisfied or very satisfied with their postoperative outcomes. Three patients with 4 helix keloids (11.1 %) felt neutral since the shape of their ears after the surgery did not match their ideal expectations; however, they experienced relief from itching and pain, and were not interested in additional treatments. Three patients with 4 helix keloids (11.1 %) were dissatisfied because of keloid recurrence, which resolved with radiotherapy or steroid injections. The mean postoperative VSS score was significantly lower than the preoperative score (P < 0.01).

The continuous zigzag excision technique is effective for treating keloids of the helix caused by burn injury. This method can achieve good cosmetic results with minimal complications and a relatively low rate of recurrence without other additional treatments.